To:
	David Aylott
	2/35 Bertram Street
	Elsternwick VIC 3185
	Australia

    From (Please PRINT):

                  Name: __________________________________
 
               Company: __________________________________

                Street: __________________________________

         City, Country: __________________________________

  	  E-mail / Fax: __________________________________


    1.  Utilities to register: ___________________________
        (some utilities can be registered separately)

    2.  Registration fee: US$____________________

    3.  Number of licences required: ____________
        (one for each PC)

    4.  Postage / Fax fee: US$___________________
	(not required if registering via e-mail)

	US$1.00 for postage or fax within Australia
	US$2.00 for postage or fax outside of Australia


    5.  TOTAL Registration fee: US$_______________
	(or the equivalent in your local currency)


    6.  Method of Payment: _________________________________________
	(eg cash or cheque)


	Signature: _______________________________  Date: __________


	Which version of WINUTILS are you using: ___________________


        Where did you discover WINUTILS: ___________________________
	

	Comments / Suggestions: ____________________________________


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